Journal «Angiology and Vascular Surgery» • 

2017 • VOLUME 23 • №4

Hybrid treatment of patients with aneurysms and dissections of the aortic arch and descending portion of the thoracic aorta

Shlomin V.V.1,2, Gordeev M.L.1, Zverev D.A.1, Shloido E.A.2, Uspenskiy V.E.1, Zvereva E.D.1, Bondarenko P.B.1, Puzdryak P.D.2

1) North-West Federal Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health,
2) Municipal Multimodality Hospital No 2, Saint Petersburg, Russia

The authors share herein their experience with hybrid surgical treatment of 21 patients presenting with lesions of the aortic arch and descending thoracic aorta. Aortic pathology included dissection of the thoracoabdominal aorta (n=15), a sacciform aneurysm of the aortic arch (n=5), and a spindle-shaped aneurysm of the distal portions of the aortic arch (n=1).

The first stage consisted of the following operations: transposition of the left subclavian artery into the left common carotid artery (n=9; 42.8%), partial debranching (n=11; 52.5%), and total debranching (n=1; 4.7%). The second stage consisted in implantation of a stent graft: to the thoracic aorta in 18 (85.8%) cases, and to the thoracic and abdominal portions of the aorta in 3 (14.2%) cases.

The most significant complications of the immediate postoperative period included acute cerebral circulation impairment (n=1) and local dissection of the ascending aorta (n=1). Type I endoleaks were observed in 4 (19%) patients, type II endoleaks in 1 (4.7%), and type III endoleaks in 1 (4.7%). The mean duration of the follow up after discharge from hospital amounted to 11.6±7.9 months. In 4 patients after 6 months the findings of the control MSCT angiography showed no significant changes of the endoleaks. 1-year patency of the shunted branches of the aortic arch amounted to 95.2%. The cumulative survival rate amounted to 95.2%.

KEY WORDS: aortic aneurysm, aortic dissection, aortic arch, descending thoracic aorta, hybrid operation, debranching, stent graft.

P. 97

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